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Acute lymphoblastic leukemia in children and adolescents: prognostic factors and analysis of survival

OBJECTIVE: To describe the clinical and laboratory features of children and adolescents with acute lymphoblastic leukemia treated at three referral centers in Ceará and evaluate prognostic factors for survival, including age, gender, presenting white blood cell count, immunophenotype, DNA index and...

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Autores principales: Lustosa de Sousa, Daniel Willian, de Almeida Ferreira, Francisco Valdeci, Cavalcante Félix, Francisco Helder, de Oliveira Lopes, Marcos Vinicios
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Sociedade Brasileira de Hematologia e Hemoterapia 2015
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4519710/
https://www.ncbi.nlm.nih.gov/pubmed/26190424
http://dx.doi.org/10.1016/j.bjhh.2015.03.009
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author Lustosa de Sousa, Daniel Willian
de Almeida Ferreira, Francisco Valdeci
Cavalcante Félix, Francisco Helder
de Oliveira Lopes, Marcos Vinicios
author_facet Lustosa de Sousa, Daniel Willian
de Almeida Ferreira, Francisco Valdeci
Cavalcante Félix, Francisco Helder
de Oliveira Lopes, Marcos Vinicios
author_sort Lustosa de Sousa, Daniel Willian
collection PubMed
description OBJECTIVE: To describe the clinical and laboratory features of children and adolescents with acute lymphoblastic leukemia treated at three referral centers in Ceará and evaluate prognostic factors for survival, including age, gender, presenting white blood cell count, immunophenotype, DNA index and early response to treatment. METHODS: Seventy-six under 19-year-old patients with newly diagnosed acute lymphoblastic leukemia treated with the Grupo Brasileiro de Tratamento de Leucemia da Infância – acute lymphoblastic leukemia-93 and -99 protocols between September 2007 and December 2009 were analyzed. The diagnosis was based on cytological, immunophenotypic and cytogenetic criteria. Associations between variables, prognostic factors and response to treatment were analyzed using the chi-square test and Fisher's exact test. Overall and event-free survival were estimated by Kaplan–Meier analysis and compared using the log-rank test. A Cox proportional hazards model was used to identify independent prognostic factors. RESULTS: The average age at diagnosis was 6.3 ± 0.5 years and males were predominant (65%). The most frequently observed clinical features were hepatomegaly, splenomegaly and lymphadenopathy. Central nervous system involvement and mediastinal enlargement occurred in 6.6% and 11.8%, respectively. B-acute lymphoblastic leukemia was more common (89.5%) than T-acute lymphoblastic leukemia. A DNA index >1.16 was found in 19% of patients and was associated with favorable prognosis. On Day 8 of induction therapy, 95% of the patients had lymphoblast counts <1000/μL and white blood cell counts <5.0 × 10(9)/L. The remission induction rate was 95%, the induction mortality rate was 2.6% and overall survival was 72%. CONCLUSION: The prognostic factors identified are compatible with the literature. The 5-year overall and event-free survival rates were lower than those reported for developed countries. As shown by the multivariate analysis, age and baseline white blood cell count were independent prognostic factors.
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spelling pubmed-45197102015-08-01 Acute lymphoblastic leukemia in children and adolescents: prognostic factors and analysis of survival Lustosa de Sousa, Daniel Willian de Almeida Ferreira, Francisco Valdeci Cavalcante Félix, Francisco Helder de Oliveira Lopes, Marcos Vinicios Rev Bras Hematol Hemoter Original Article OBJECTIVE: To describe the clinical and laboratory features of children and adolescents with acute lymphoblastic leukemia treated at three referral centers in Ceará and evaluate prognostic factors for survival, including age, gender, presenting white blood cell count, immunophenotype, DNA index and early response to treatment. METHODS: Seventy-six under 19-year-old patients with newly diagnosed acute lymphoblastic leukemia treated with the Grupo Brasileiro de Tratamento de Leucemia da Infância – acute lymphoblastic leukemia-93 and -99 protocols between September 2007 and December 2009 were analyzed. The diagnosis was based on cytological, immunophenotypic and cytogenetic criteria. Associations between variables, prognostic factors and response to treatment were analyzed using the chi-square test and Fisher's exact test. Overall and event-free survival were estimated by Kaplan–Meier analysis and compared using the log-rank test. A Cox proportional hazards model was used to identify independent prognostic factors. RESULTS: The average age at diagnosis was 6.3 ± 0.5 years and males were predominant (65%). The most frequently observed clinical features were hepatomegaly, splenomegaly and lymphadenopathy. Central nervous system involvement and mediastinal enlargement occurred in 6.6% and 11.8%, respectively. B-acute lymphoblastic leukemia was more common (89.5%) than T-acute lymphoblastic leukemia. A DNA index >1.16 was found in 19% of patients and was associated with favorable prognosis. On Day 8 of induction therapy, 95% of the patients had lymphoblast counts <1000/μL and white blood cell counts <5.0 × 10(9)/L. The remission induction rate was 95%, the induction mortality rate was 2.6% and overall survival was 72%. CONCLUSION: The prognostic factors identified are compatible with the literature. The 5-year overall and event-free survival rates were lower than those reported for developed countries. As shown by the multivariate analysis, age and baseline white blood cell count were independent prognostic factors. Sociedade Brasileira de Hematologia e Hemoterapia 2015 2015-04-14 /pmc/articles/PMC4519710/ /pubmed/26190424 http://dx.doi.org/10.1016/j.bjhh.2015.03.009 Text en © 2015 Associaҫão Brasileira de Hematologia, Hemoterapia e Terapia Celular. Published by Elsevier Editora Ltda. All rights reserved. http://creativecommons.org/licenses/by-nc-nd/4.0/ This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
spellingShingle Original Article
Lustosa de Sousa, Daniel Willian
de Almeida Ferreira, Francisco Valdeci
Cavalcante Félix, Francisco Helder
de Oliveira Lopes, Marcos Vinicios
Acute lymphoblastic leukemia in children and adolescents: prognostic factors and analysis of survival
title Acute lymphoblastic leukemia in children and adolescents: prognostic factors and analysis of survival
title_full Acute lymphoblastic leukemia in children and adolescents: prognostic factors and analysis of survival
title_fullStr Acute lymphoblastic leukemia in children and adolescents: prognostic factors and analysis of survival
title_full_unstemmed Acute lymphoblastic leukemia in children and adolescents: prognostic factors and analysis of survival
title_short Acute lymphoblastic leukemia in children and adolescents: prognostic factors and analysis of survival
title_sort acute lymphoblastic leukemia in children and adolescents: prognostic factors and analysis of survival
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4519710/
https://www.ncbi.nlm.nih.gov/pubmed/26190424
http://dx.doi.org/10.1016/j.bjhh.2015.03.009
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